The Supreme Court ruled 5-4 in Burwell v. Hobby Lobby on Monday that for-profit employers with religious objections can opt out of providing contraception coverage under Obamacare.

The ruling deals directly with only a small provision of Obamacare and will not take down the entire law but it amounts to a huge black eye for Obamacare, the administration and its backers. The justices have given Obamacare opponents their most significant political victory against the health care law, reinforcing their argument that the law and President Barack Obama are encroaching on Americans’ freedoms.

“We doubt that the Congress that enacted [Religious Freedom Restoration Act] — or, for that matter, ACA – would have believed it a tolerable result to put family-run businesses to the choice of violating their sincerely held religious beliefs or making all of their employees lose their existing healthcare plans,” Justice Samuel Alito wrote in the opinion, which was joined by Chief Justice John Roberts and Justices Antonin Scalia, Clarence Thomas and Anthony Kennedy.

The court’s four liberal justices called it a decision of “startling breadth” and said that it allows companies to “opt out of any law (saving only tax laws) they judge incompatible with their sincerely held religious beliefs.”

The court’s majority also rejected the Obama administration’s argument that for-profit companies cannot assert religious rights under RFRA. However, only Justice Sonia Sotomayor joined the portion of Justice Ruth Bader Ginsburg’s dissent that argues companies do not have such rights.

Justices Stephen Breyer and Elena Kagan did not join that section of Gingsburg’s opinion and said in a one-paragraph dissent of their own that they would have left for another day the issue of the rights of for-profit companies and their owners.

The majority decision could open the door to other closely held corporations seeking to withhold coverage for other medical procedures at odds with firm religious beliefs. It marks the first time that the Supreme Court has allowed companies the ability to declare a religious belief — a decision that could reverberate far past the Affordable Care Act to other laws and issues.

In the short term, the ruling appears to allow the owners of Hobby Lobby and Conestoga Wood Specialties to opt out of the health care law’s requirement that they provide all Food and Drug Administration-approved forms of birth control in their health plans.

The court’s latest decision promises to reignite a national debate over women’s health and access to contraception ahead of this fall’s midterm elections. It is likely to force House and Senate candidates to answer for whether they supported the contraception coverage, a provision that’s more politically popular than the law itself. Advocates have promised to make it an election issue.

The Obama administration and women’s health groups have warned that if they lost in the Supreme Court, the ruling could have much broader health coverage implications. If a company can skirt the contraception requirement, what’s to prevent another employer from objecting to providing access to vaccines or blood transfusions on religious grounds, they asked.

Justice Ginsburg, in her dissent, warned that the ruling that would have wide repercussions and “untoward effects.”

“Although the court attempts to cabin its language to closely held corporations, its logic extends to corporations of any size, public or private,” she wrote.

The Obama administration argued that the requirement wasn’t a mandate at all because the companies could have dropped coverage.

The court’s conservative justices accuse the Obama administration and the dissent of questioning the religious beliefs of the families that own the two closely-held companies, in particular the owners’ position that providing the contraceptive coverage would put a substantial burden on their religious views.

“[Health and Human Services] and the principal dissent in effect tell the plaintiffs that their beliefs are flawed. For good reason, we have repeatedly refused to take such a step,” Alito wrote.

Ginsburg and the dissenters sharply disagreed with the pointed critique.

“The Court levels a criticism that is as wrongheaded as can be. In no way does the dissent ‘tell the plaintiffs that their beliefs are flawed,” she wrote. “Right or wrong in this domain is a judgment no Member of this Court, or any civil court, is authorized or equipped to make. What the Court must decide is not ‘the plausibility of a religious claim…’ but whether accommodating that claim risks depriving others of rights accorded them by the laws of the United States.”

“If the Supreme Court will not protect women’s access to health care, then Democrats will,” Reid said in a statement. “We will continue to fight to preserve women’s access to contraceptive coverage and keep bosses out of the examination room.”

He said the court made clear that “the Obama administration cannot trample on the religious freedoms that Americans hold dear” by requiring businesses to cover birth control in employee-health plans under the ACA.

McConnell called Obamacare “the single worst piece of legislation to pass in the last 50 years” and praised the court for agreeing that the contraception requirement violates the RFRA.

The challenges were brought by the Oklahoma-based Hobby Lobby Stores Inc., a national craft store chain owned by evangelical Christians with more than 13,000 employees, and Conestoga Wood Specialties, a small Pennsylvania cabinet company owned by Mennonites.

The owners of both said they have religious objections to providing access to certain forms of contraception — Plan B, Ella and certain intrauterine devices, which they call abortifacients — in their employee health plans. They had the backing of the Catholic bishops, several Republican lawmakers and at least 50 other for-profit companies that have filed similar legal challenges.

There is a separate string of lawsuits filed against the same policy by religious-affiliated groups, such as Catholic schools.

During a rare 90-minute session of oral arguments before the justices, the companies argued that the Obama administration is forcing them and their owners to set aside deeply held religious beliefs by requiring them to provide contraception in their employee health plans. The owners said they cannot have any role in providing access to certain forms of contraception without having to violate those beliefs. Their attorney, former Republican Solicitor General Paul Clement, said that because the Obama administration has provided some exemptions to the rule — for churches and certain nonprofits — it should be willing to exempt companies, too.

Scalia was not at the court on Monday and a court spokeswoman said he was traveling.